WHERE AND HOW SHOULD ELDERLY STROKE PATIENTS BE TREATED - A RANDOMIZED TRIAL

Background and Purpose Elderly stroke patients in particular are at ri sk of receiving less than optimal care. We studied the effects of the department care (medicine versus neurology) on the outcome of elderly stroke patients in a randomized controlled trial with 1-year follow-up . Methods A total of 243 consecutive patients aged 65 years or older w ith acute stroke were randomized to receive care in the Departments of Medicine or the Department of Neurology of a university teaching hosp ital with a referral area of 1.1 million. The outcome was assessed by mortality, length of hospital stay, ability to live at home on dischar ge, Barthel Index, and Rankin grades at 1-year. Results There were no differences in sex and age, severity or type of stroke, other diseases , or social factors between the two groups. One-year mortality was 21% in both patients treated by the Departments of Medicine and those tre ated by the Department of Neurology. Patients treated by the Departmen t of Neurology were discharged an average of 16 days earlier (24 versu s 40 days). The length of hospital stay of patients aged younger than 75 years differed significantly (P=.02). Patients randomized to neurol ogical wards more often went directly home (75% versus 62%; P=.03), an d their functional status was better as assessed with Barthel Index an d Rankin grades at 1 year (P=.02 and P=.03, respectively). Independent predictors of a better functional outcome and shorter hospital stay b y stepwise multivariate analysis included management by the Department of Neurology. Conclusions Well-organized management of elderly stroke patients was associated with a better outcome. It was also the more e conomical alternative.